The important role of nursing leadership in the implementation of a fast-track early recovery care pathway after paediatric cardiac surgery

Abstract

Background: 'Fast-Track' is an early recovery after surgery (ERAS) care pathway that was introduced for the first time in Australia for selected patients following cardiac surgery at the Queensland Children's Hospital in October 2019. The implementation of this multi-disciplinary care pathway was coordinated by the cardiac surgical nursing team. Support and education of patients and families was an additional goal of the nursing facilitators. Methods: Prior to Fast-Track, cardiac surgical patients remained in the intensive care unit (ICU) for a minimum of one night. Every part of the patient care pathway from time of acceptance for cardiac surgery through to discharge was re-examined looking for ways to optimise and rationalise interventions. Change management was coordinated and evaluated by nursing facilitators who provided support and direction to the multidisciplinary teams caring for these patients. After the introduction of the Fast-Track care pathway, perioperative data was collected on all patients enrolled in the pathway between October 2019 and February 2023. Patients remained in intensive care for 2-6-hours before transfer to the ward on the same day. Results: During the study period, 100 patients were cared for using the Fast-Track care pathway. Procedures included atrial septal defect (n= 48, 48%), vascular ring (n=14, 14%), and ventricular septal defects (n=11, 11%). Median age at surgery was 4.8 years (IQR 2.8-9.4). 84 (84%) patients were extubated in the operating theatre. Median length of stay in ICU was 4.4 hours (IQR 3.8- 5.3). 84 (84%) patients were transferred to the ward on the day of surgery. No patient required readmission to the ICU within 24 hours of ICU discharge. Feedback reports from families emphasised the positive impact of enabling them to remain in a de-intensified setting at their child's bedside overnight and participate in the delivery of basic cares. Conclusion: A Fast-Track ERAS care pathway is family centred and can be safely implemented in a selected group of paediatric cardiac surgical patients. Nursing coordinators are essential to facilitate the breakdown of silos between disciplines and enable implementation and rapid evaluation of practice changes associated with ERAS.